resurrection health care physicians’ health insurance initiative presented by: steve guarino pbt...

RESURRECTION HEALTH CARE PHYSICIANS’ HEALTH INSURANCE INITIATIVE

Presented by:

Steve Guarino

PBT Health Insurance Program

PBT Health Insurance ProgramPhysicians’ Benefits Trust presents a group health plan offering specifically created for

Resurrection Health Care physicians, their employees and their families. The PBT Advantage:

•Designed by physicians to meet the health plan needs of medical professionals.

•The Program continues to be managed by physicians.

•A wholly owned subsidiary of ISMIE Mutual Insurance Company.

•The plans are completely portable for physicians and their families. If a physician leaves the Resurrection Health Care affiliation, coverage is guaranteed under a standard PBT health plan.

•Dependant coverage up to age 25. (Older if they are students.)


The PBT Advantage Cont.: Continuation of PBT coverage if retirement occurs before age 65.

Eligibility to transfer to PBT Medicare supplement plans post 65 without pre-existing condition limitations.

No pre-certification or second-opinion requirements (except for Organ Transplant).

Group bill specific to each physician or physician group.

Free and unrestricted choice of doctors and hospitals with higher benefit levels for care received at Resurrection Health Care facilities.

PBT Dedicated Customer Service teams to ensure accurate and quick responses and claims handling.


RHC Physicians’ Initiative / PBT Health Plan Offering:

PBT has designed the following 3-tiered health benefit plans specifically for RHC affiliated physicians and their employees. Consideration has been given for when members seek care at RHC facilities and a higher benefit (1st tier) is paid for those services. (Plan designs and rate details are attached.)

Preferred Provider Options: Plan A: 80/60/50

Deductible Options - $300, $500, $1000, $2000 or $3000 Plan B: 90/80/50

Deductible Options - $300, $500, $1000, $2000 or $3000 Plan C: 100/90/50

Deductible Options - $2500 or $5000


RHC Physicians’ Initiative / PBT Health Plan Offering Cont.:

HSA Qualifying High Deductible Plan: 100/80/60 Plan

Individual/Family Deductible Options - $1800/$3600 or $2900/$5600 All plans include $10,000 of Term Life Coverage and co-pay Caremark

prescription plan. Dental coverage with $25 or $50 deductibles can also be made available.


Program General Guidelines and Eligibility Requirements:

Employer groups can offer up to three different RHC plans and three deductibles.

The plan is only open to physicians affiliated with Resurrection Health Care, their employees and their families.

Each group enrolling must have at least one physician insured in the plan.

Quotes will be provided for the entire group. However, not all group employees need to participate and can elect to decline coverage on the application form.

PBT has contracted with a large preferred provider network to provide second tier facility services and in-network physician services.


Preferred Provider Options Plan Designs


Preferred Provider Option

Deductible Choices $300 $500, $1,000, $2000,$3000

RHC Facilities In - Network Out-of-Network

Hospital Coinsurance Percentage

PBT pays 80% of Next $5,000 of Eligible

Charges*

PBT Pays 60% of Next $5,000 of Eligible Charges*


Physician Coinsurance PercentagePBT pays 80% of Next

$5,000 of Eligible Charges*PBT Pays 60% of Next $5,000 of

Eligible Charges*

Individual Annual Out-of-Pocket Maximum*

$1,000 Plus Deductible $5,000 Plus Deductible

Physician Office Visit $20 Co-Pay then 100%Subject to Deductible &

Coinsurance

Preventative Care Benefit80% Not subject to

Deductible50% Subject to Deductible

Maximum Benefit $500

Managed Care Requirements

None - Except for organ transplants

* Physician Charges and Hospital Charges are combined toward the $5,000 threshold.

** Family Deductible and Out-of-Pocket Maximum is two times the individual.

RHC PHYSICIANS’ PBT Plan A


RHC PHYSICIANS’ PBT Plan B

Preferred Provider Option (PPO B 90% Plans)

Deductible Choices $300, $500, $1000, $2000, $3000


Hospital Coinsurance

Percentage

PBT pays 90% of Eligible Charges* after Deductible

PBT Pays 80%% of Next $10,000 of Eligible Charges*


Physician Coinsurance PercentagePBT pays 90% of Eligible Charges* after Deductible

Subject to Deductible then PBT Pays 80% of Eligible Charges

Physician Office Visits***First 3 annually at 90% (not

subject to deductible)First 3 annually at 80% (not

subject to deductible)


$500 plus Deductible $1,000 Plus Deductible

Preventative Care Benefit 90% Not subject to Deductible80% (not subject to deductible) Maximum annual benefit $500



* Physician Charges and Hospital Charges are combined toward the $10,000 threshold.

** Family Deductible and Out-of-Pocket Maximum is two times the individual.

*** In -and-Out -Network: Thereafter, deductible and coinsurance applies.


RHC PHYSICIANS’ PBT Plan C

Preferred Provider Option

Deductible Choices $2500 or $5000



PBT pays 100% of Eligible Charges* after Deductible



Physician Coinsurance PercentagePBT pays 100% of Eligible Charges* after Deductible

Subject to Deductible then PBT Pays 90% of Eligible

Charges


Deductible Amount $1,000 Plus Deductible

Preventative Care Benefit100% Not subject to

Deductible

90% (not subject to deductible) Maximum annual

benefit $500




HSA Qualified High Deductible Plans Plan Design


Health Savings Account Qualifying High Deductible Plan

Deductible Choices $1,800 ($3,600 Family) or $2,900 ($5,600 Family)

RHC Facilities $1,800 and $2,900

Plans

In - Network $1,800 and $2,900

PlansOut-of-Network $1,800

DeductibleOut-of-Network

$2,900 Deductible


After deductible, PBT pays 100% of

Eligible Charges

After deductible, PBT pays 80% of Eligible

Charges

After deductible, PBT pays 60% of next $6,750

($13,500 for families*) of eligible charges**

After deductible, PBT pays 60% of next

$5,000 ($15,500 for families*) of eligible

charges**

Physician Coinsurance PercentageAfter deductible, PBT

pays 100% of Eligible Charges

After deductible, PBT pays 60% of next $6,750

($13,500 for families) of eligible charges*

After deductible, PBT pays 60% of next

$5,000 ($15,500 for families) of eligible

charges*

Your Annual Out-of-Pocket Maximum

Individual $1,800 Family: $3,600 or Individual $2,900 Family $5,600

Individual: $3,150 Family: $6.300

Individual: $3,500 Family: $6,800

Physician Office Visit Payable as any other benefit.

Preventative Care BenefitNot subject to

deductible. Payable at 100%

Not subject to deductible. Payable at 80%. Maximum

annual benefit $500

Not subject to deductible. Payable at 80%. Maximum

annual benefit $500


None - Except for organ transplants* Then 100% of eligible charges.

RHC Physicians' PBT Plan

resurrection health care physicians’ health insurance initiative presented by: steve guarino pbt...

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